ORE Part 2 Patient Management — Questions and Answers
Question 1: A patient with severe dental anxiety refuses treatment despite being in pain. What is the most appropriate initial approach?
- Insist on treatment as it is in their best interest
- Use cognitive behavioural techniques, discuss sedation options, and develop a graded treatment plan (Correct answer)
- Refer for general anaesthetic immediately
- Prescribe antibiotics and discharge
Correct answer: Use cognitive behavioural techniques, discuss sedation options, and develop a graded treatment plan
A patient-centred approach involves acknowledging the patient's anxiety, using evidence-based psychological techniques (CBT, relaxation, Tell-Show-Do), discussing conscious sedation options (inhalation or IV), and developing a graded exposure plan starting with less invasive procedures. Forcing treatment violates autonomy and is ethically unacceptable.
Question 2: According to GDC Standards for the Dental Team, which principle requires dentists to always put patients' interests first?
- Principle 1: Put patients' interests first (Correct answer)
- Principle 3: Obtain valid consent
- Principle 6: Work with colleagues in a way that is in patients' best interests
- Principle 9: Make sure your personal behaviour maintains patients' confidence
Correct answer: Principle 1: Put patients' interests first
GDC Principle 1 states 'Put patients' interests first.' This overarching principle underpins all clinical decision-making and professional conduct. It encompasses providing appropriate care, acting in the patient's best interest even when it conflicts with personal or financial interests, and maintaining trust in the profession.
Question 3: What constitutes valid consent for dental treatment in the UK?
- Verbal agreement only
- The patient signing a consent form
- The patient having capacity, being informed of all material risks and alternatives, and consenting voluntarily without coercion (Correct answer)
- The patient's family agreeing on their behalf
Correct answer: The patient having capacity, being informed of all material risks and alternatives, and consenting voluntarily without coercion
Valid consent requires three elements: (1) the patient must have capacity to understand and retain the information, (2) they must be informed of the nature, purpose, risks, benefits, and alternatives to the proposed treatment (Montgomery v Lanarkshire, 2015), and (3) consent must be given voluntarily without duress. A signed form alone does not constitute valid consent.
Question 4: A patient collapses in the dental chair with chest pain radiating to the left arm and jaw. After calling 999, what is the immediate management while awaiting the ambulance?
- Continue dental treatment to finish quickly
- Sit the patient upright, give aspirin 300mg to chew, and GTN spray if available and BP adequate (Correct answer)
- Lay the patient flat and elevate the legs
- Give intramuscular adrenaline
Correct answer: Sit the patient upright, give aspirin 300mg to chew, and GTN spray if available and BP adequate
The signs suggest acute myocardial infarction. After calling 999, sit the patient in a comfortable position (often upright or semi-recumbent), give 300mg aspirin to chew (unless allergic), administer GTN spray sublingually if the systolic BP is above 90mmHg, and provide supplemental oxygen if SpO2 is below 94%. Monitor and be prepared to commence CPR if the patient arrests.
Question 5: Under the Mental Capacity Act 2005, how should treatment decisions be made for an adult patient who lacks capacity?
- The dentist decides alone based on clinical need
- The next of kin gives consent on behalf of the patient
- A best interests decision is made considering the patient's past wishes, values, and involving relevant people in the decision (Correct answer)
- Treatment cannot be provided until capacity is regained
Correct answer: A best interests decision is made considering the patient's past wishes, values, and involving relevant people in the decision
Under the Mental Capacity Act 2005, when a patient lacks capacity, decisions must be made in their 'best interests.' This involves considering the patient's past and present wishes, feelings, beliefs and values; consulting with family, carers, and any appointed lasting power of attorney; and choosing the least restrictive option. Next of kin do not have automatic legal authority to consent.
Question 6: A patient requests that their dental records be shared with a new dentist. Under UK GDPR, what is the correct procedure?
- Refuse as records are the property of the practice
- Share the records immediately without any formalities
- Obtain written consent from the patient and provide copies of relevant records within one month (Correct answer)
- Only share records with a court order
Correct answer: Obtain written consent from the patient and provide copies of relevant records within one month
Under UK GDPR (Data Protection Act 2018), patients have the right to access their personal data and request its transfer. The dentist should obtain written consent, provide copies of the records (not originals) within one month of the request, and can charge a reasonable fee for excessive requests. This is part of the patient's Subject Access Rights.
ORE Part 2 Patient Management
A patient with severe dental anxiety refuses treatment despite being in pain.
What is the most appropriate initial approach?